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Rheumatic Associations of Autoimmune Thyroid Disease: a Systematic Review

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Rheumatic Associations of Autoimmune Thyroid Disease: a Systematic Review Clinical Rheumatology (2019) 38:1801–1809 https://doi.org/10.1007/s10067-019-04498-1 REVIEW ARTICLE Rheumatic associations of autoimmune thyroid disease: a systematic review Clement E. Tagoe1,2 & Tejas Sheth3 & Eugeniya Golub1 & Karen Sorensen4 Received: 5 February 2019 /Revised: 22 February 2019 /Accepted: 27 February 2019 /Published online: 29 March 2019 # International League of Associations for Rheumatology (ILAR) 2019 Abstract To investigate specific disease patterns in the rheumatic manifestations associated with autoimmune thyroid disease (AITD) through a systematic literature review. We performed a systematic review using the Medline OVID, PubMed, EMBASE, and Web of Science databases through May 2018 for experimental and observational studies that explored the association of AITD with degenerative joint disease (DJD), osteoarthritis (OA), chronic widespread pain (CWP) and fibromyalgia syndrome (FMS), and seronegative inflammatory arthritis (IA). A total of 2132 articles were identified. After title and abstract screening and removal of duplicates, 66 articles were retrieved for full text review. Eighteen studies were deemed eligible for inclusion. Six observational studies reported up to 45% prevalence of DJD in AITD. Hand and spinal DJD were reportedly associated with higher odds of AITD. Twelve observational studies were retrieved reporting up to 62% prevalence of FMS in AITD patients. Four studies described the occurrence of seronegative IA in AITD patients. The rheumatic associations of AITD may manifest specific patterns of disease distinct from those of other well-defined autoimmune syndromes and contribute significantly to disease burden. Keywords Autoimmunethyroiddisease .Chronicwidespreadpain .Fibromyalgia .Hashimotothyroiditis .Osteoarthritis .Spinal degenerative disc disease Introduction proportion of patients with Graves’ disease may present with clinically significant hyperthyroidism and Graves’ The autoimmune thyroid diseases (AITD) comprise a spec- ophthalmopathy. Chronic lymphocytic thyroiditis (CLT) and trum of diseases with considerable clinical overlap that are its goitrous form Hashimoto thyroiditis (HT) are characterized typified histologically by the invasion of the thyroid gland by circulating antithyroid peroxidase antibodies (TPOAb) by lymphocytes [1]. Graves’ disease is characterized by the and/or antithyroglobulin antibodies (TgAb). Hashimoto thy- presence of antithyrotropin (TSH) receptor antibodies, respon- roiditis is the commonest cause of hypothyroidism, although sible for over activation of the thyroid gland. A significant at presentation patients can be euthyroid or even hyperthyroid [2]. Less well recognized are the rheumatic manifestations of AITD. The genetic associations of AITD overlap with those of Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10067-019-04498-1) contains supplementary the autoimmune connective tissue diseases (ACTD), and thus, material, which is available to authorized users. AITD is enriched in families with ACTD [3–7]. Indeed, AITD is the most common autoimmune disease with the prevalence * Clement E. Tagoe of CLT alone estimated conservatively to be around 10% of [email protected]; [email protected] the population in studies using the antithyroid autoantibodies TPOAb and TgAb as markers of disease [8]. Similarly, pa- 1 Division of Rheumatology, Department of Medicine, Albert Einstein tients with AITD have an increased incidence of ACTD, College of Medicine, Bronx, NY, USA which impacts the clinical presentation of the former [9]. 2 Division of Rheumatology, Montefiore Medical Center, 111 East Thyroid autoimmunity has been described as a classic ex- 210th Street, Bronx, NY 10467-2490, USA ample of organ-specific autoimmunity [10]. However, a grow- 3 Waterbury Hospital, Waterbury, CT, USA ing body of evidence suggests that thyroid autoimmunity per- 4 Albert Einstein College of Medicine, Bronx, NY, USA haps occurs as part of a more generalized autoimmune process 1802 Clin Rheumatol (2019) 38:1801–1809 in a significant proportion of patients where an overlap with Fibromyalgia and chronic widespread pain were defined using other autoimmune diseases exists [11, 12]. Furthermore, there the American College of Rheumatology (ACR) 1990 defini- is emerging evidence that rheumatic manifestations can occur tion and the updated criteria respectively [16, 17]. in AITD patients in the absence of well-defined ACTD or Osteoarthritis of the hip, knee, and hand were defined using clinically significant endocrine disease. Thus, association of the ACR criteria for each respectively [18–20]. Spinal osteo- AITD with chronic widespread pain (CWP) and fibromyalgia arthritis was defined by the radiographic presence of degener- syndrome (FMS), peripheral osteoarthritis (OA), spinal oste- ative joint disease (DJD) or degenerative disc disease (DDD) oarthritis, and seronegative inflammatory arthritis (IA) has respectively. Inflammatory arthritis was included if it was se- been described even in the absence of clinical hypothyroidism ronegative and not due to a well-defined ACTD, undifferen- [13]. Most of the emerging literature focuses on the rheumatic tiated connective tissue disease (UCTD), or other well-defined associations of CLT and HT which are much more common autoimmune syndrome and could thus be attributed to the than those of Graves’ disease. Despite the increasing appreci- presence of AITD alone. ation of the rheumatologic impact of AITD, the rheumatology The review was performed according to the Preferred community has been slow to incorporate testing for AITD into Reporting Items for Systematic Reviews and Meta-analyses clinical practice. (PRISMA) checklist ( S1 Table) and statement [21]. General reviews have suggested patterns of musculoskele- Experimental, quasi-experimental, and observational human tal manifestations of AITD, including OA, FMS and CWP, studies published in English which addressed the presence and spinal osteoarthritis. The objective of this review is to of the abovementioned comorbidities in patients with AITD provide an initial systematic review to investigate the avail- or vice versa were included. Qualitative research designs, re- able scientific evidence for a characteristic pattern of rheumat- view articles, meeting abstracts, protocols, and case reports ic manifestations of CLT and HT, outside of the musculoskel- were excluded. If a study addressed a heterogeneous group etal manifestations of overlap with connective tissue diseases of patients, the study was included if the results for patients or other autoimmune inflammatory syndromes. meeting our inclusion criteria were reported separately. The authors evaluated titles and abstracts of the references identified by means of the search strategy independently. The Materials and methods full texts of articles of interest were evaluated for inclusion. Any discrepancies between the reviewers were resolved by Search strategy consensus. Data pertaining to included studies were extracted independently using a standardized format by two authors (TS A comprehensive search was conducted in the MEDLINE and CT or EG and CT) and verified subsequently by the third OVID database as suggested by Haynes et al. (up until author. A narrative synthesis with tabulated results was per- May 31, 2018) [14, 15]. A medical librarian (KS) performed formed. Due to the high heterogeneity in design and outcome searches in three additional databases: PubMed; Embase on measures of the included studies, it was not feasible to com- Embase.com, which includes the years 1971–present; and bine data by means of meta-analysis. The study selection Web of Science, which includes the years 1985–present. For flowchart and results of the search strategy are shown in the PubMed searches, MeSH terms including Fig. 1. (BFibromyalgia,^ BChronic Pain,^ BOsteoarthritis,^ or BArthritis, Rheumatoid^)werecombinedwith(BThyroiditis, Autoimmune^ OR ((BThyroid Gland,^ OR BThyroid Results Diseases^)AND(BAutoimmune Diseases^ OR BAutoantibodies^[Mesh] OR BAutoimmunity^))). Title and Search outcome and level of evidence abstract words were included in the search. For the Embase search, Emtree terms and title and abstract words were A total of 2132 references were identified. After exclusion of searched. A topic search was conducted in Web of Science. duplicates, 1280 titles and abstracts were reviewed for rele- Supplementary Appendix A provides the complete PubMed vance to the topic. Sixty-six articles were reviewed in full text search. The associated rheumatic diseases were grouped into version. A total of 18 studies met the inclusion criteria for three groups: Group 1—degenerative arthritis or OA review, isolating studies that analyzed the MSK findings in (Supplementary Appendix A1); Group 2—FMS or CWP syn- AITD patients, not attributable to overlapping ACTD. Of the dromes (Supplementary Appendix A2); and Group 18, six, twelve, and four studies addressed the association of 3—seronegative IA (Supplementary Appendix A3). These AITD with osteoarthritis or degenerative joint disease, FMS searches were then complemented with a review of the refer- or CWP syndrome, and seronegative inflammatory arthritis, ence bibliographies of the review articles identified thus far to respectively. All the isolated studies were observational stud- detect any relevant studies left out by the initial search. ies. Level of evidence was judged using the grading of Clin Rheumatol (2019) 38:1801–1809 1803 Web of MEDLINE EMBASE
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